ASSESSMENT OF THE BREASTS OBJECTIVE DATA

Inspect the Breast

● General appearance
⮚ Symmetric, shape
- Slight asymmetric normal (often
L> R)

SKIN

● Smooth, even color

● Note redness, bulging, dimpling, lesions, or
focal vascular pattern.
⮚ Fine blue vascular network normal
during pregnancy
⮚ Pale linear striae may occur after
pregnancy.
● Edema should not be present.
⮚ Look for an orange peel
appearance.

GENERAL APPEARANCE OF
BREASTS

PREPARATION

● Inspection in sitting position, client disrobed

to waist, facing examiner.
● Can use a short gown.
⮚ Opening at back & lift to shoulders
during exam
⮚ Opening in front, keep closed while
watching & open during exam.
● During palpation, use supine position &
expose one breast at a time.
● Use a sensitive but matter of fact approach.
● Warm hands
 ⮚ Note recent retraction on inversion.

⮚ Normal nipple inversion is usually

not fixed.
● Note dry scaling, fissures, ulcerations,
bleeding, discharge.
● Supernumerary nipple along embryonic
milk line
⮚ Usually, 5 to 6 cm below breast near
midline & no associated glandular
tissue.

INSPECT FOR RETRACTIONS:

POSITION 1

SUPERNUMERARY NIPPLE
● Lift arms slowly over head
● Both breasts should move up symmetrically.

INSPECT FOR RETRACTIONS:

POSITION 2

OBJECTIVE DATA

Inspect the Breast

● Push hands into hips & push palms together
Nipple ● Slight lifting of both breasts

● Symmetry, protrusion INSPECT FOR RETRACTIONS:

-Most protrude, some flat or inverted. POSITION 3
● If large pendulous breasts, lean over &
support forearms. OBJECTIVE DATA
● Symmetric, free forward movement
Palpate the breast.

● Nulliparous: Firm, smooth, elastic tissue

● After pregnancy: Softer, looser tissue.
● Premenstrual: Engorgement, tenderness,
INSPECT AND PALPATE AXILLA
generalized nodularity
● Inframammary ridge: Normal, noticeable in
large breasts in lower quadrants.
● Large, pendulous breast: May use bimanual
technique in sitting position, leaning
forward.

BREAST PALPATION

PALPATE BREAST

LOCATING BREAST ABNORMALITIES

PATTERN OF BREAST PALPATION

 BREAST LUMPS
ABDOMINAL ASSESSMENT
STRUCTURE AND FUNCTION

MALE BREAST PALPATION

REVIEW STRUCTURE & FUNCTION

ABDOMINAL QUADRANTS
ADOLESCENT GYNECOMASTIA
 above the head/folding behind the
head-tense the abdominal muscles.
⮚ Palpate tender areas last.

⮚ Instruct-breath through the mouth

and take slow, deep breaths.
⮚ Auscultate after you inspect so as
not alter the client’s pattern of
bowel sounds.
⮚ Ticklishness- put the client’s hands
under your own.
⮚ Warm rub together

OBJECTIVE DATA

INSPECT THE ABDOMEN

● Contour
⮚ Assess at eye level.
- Protuberant, distension
⮚ Determine profile from rib margin
to pubic bone.
PREPARATION ● Symmetry
● Adequate lighting ⮚ Note localized bulging, visible mass,
● Expose abdomen, drape genitalia & female or asymmetry.
breast. - Hernia
● Stand on the client's right side.
⮚ Use light if available.

⮚ Assess form R side & foot.

● Measures to relax the abdomen. ● Umbilicus

⮚ Empty bladder before exam ⮚ Normally midline & inverted, no

discoloration, inflammation,
⮚ Warm room, hands & stethoscope discharge, or hernia.
- May be inverted during
⮚ Keep your fingernails short.
pregnancy.
⮚ Supine, HOB lowered, head on - Sunken in obesity.
pillow, knees bent or on pillow,
arms at side or across chest raising
 OBJECTIVE DATA

INSPECT THE ABDOMEN

SKIN

● Normally smooth, even color, good turgor,

● Abdominal skin may be paler than the
general skin tone because this skin Is so
seldom exposed to the natural elements.
● Scattered fine veins may be visible. Blood in
the veins located above the umbilicus flows
toward the head; blood in the veins located
below the umbilicus flows toward the lower
body.
● New striae are pink or bluish in color; old
striae are silvery, white, linear, and uneven
stretch marks from past pregnancies or
weight gain.
● Abdomen is free of lesions or rashes. Flat or
raised brown moles, however, are normal
and may be apparent.
● Umbilicus is midline at the lateral line.
● It is recessed (inverted) or protruding no
more than 0.5 cm and is round or conical.
● Abdomen is flat, rounded, or scaphoid.
Abdomen should be evenly rounded.
no lesions.
- May see moles (brown macular
or popular areas)
- Note scars: location, length,
healing.
- Redness with localized infection
● Striae present after weight loss or
pregnancy.
- Silvery-white, linear, jagged
marks
- If recent, they’re pink or blue;
then turn silvery white later.
● Veins normally not present.
- If thin, may see fine venous
network.
● Inspect the Abdomen
⮚ Pulsation or movement
- May see aortic pulsation in the
epigastric area if thin.
- Males tend to be abdominal
breathers- may note
respirations.
- Waves of peristalsis sometimes
seen if thin.
→ Ripple slowly & obliquely
across the abdomen.
● Hair distribution
⮚ Pubic hair
- Diamond shape in males
- Inverted triangle in females
● Demeanor
⮚ Comfort

AUSCULTATE BOWEL SOUNDS

Bowel sounds
● Note character & frequency.
● Normal
 ● Dullness
⮚ High pitched, gurgling, cascading
⮚ Bladder distention
⮚ Occur irregularly (5-30 times/min).
⮚ Do not count them. ⮚ Adipose tissue
⮚ Assess: normal, hypoactive, or
⮚ Fluid/mass
hyperactive
⮚ Hypoactive- or absent OBJECTIVE DATA
⮚ Hyperactive- loud, high pitched
PALPATE THE ABDOMEN
rushing sounds.
● Must listen for 5 minutes before deciding BS ● Begin with light palpation to assess skin
is completely absent. surface & superficial musculature (1-2 cm
● Borborygmus deep)

⮚ Hyperperistalsis when you are ⮚ Move clockwise.

hungry. ⮚ Save tender areas for last.

AUSCULTATE VASCULAR SOUNDS ⮚ Check for involuntary rigidity vs.

● Auscultate Vascular Sounds voluntary guarding.
⮚ Note the presence of vascular ● Perform deep palpation (5-8 cm deep)

sounds or bruits. ⮚ Move clockwise exploring the entire

- Especially in people with HTN abdomen.
- Location, pitch, and timing.
⮚ If obese, use a bimanual technique.
● Use bell endpiece with firm pressure to
form a seal & check over the: ⮚ Note location, size, consistency &
⮚ Aorta mobility of palpable organs or
presence of masses or tenderness.
⮚ Renal arteries - Mild tenderness over sigmoid
⮚ Iliac arteries colon normal
● ⺁rebound tenderness if client reports pain
⮚ Femoral arteries or tenderness during exam.

PERCUSSION EXAMINATION OF THE HEART

Percuss the Abdomen
● General tympany
⮚ 1st percuss lightly in all 4 quadrants.
- Tympany should be
predominant.
→ Air in the intestines rises
when supine.
 Electrical impulse spreads from the sinus
node throughout left and right atria
causing the atria to contract and
expelling its volume of blood into the
ventricle.

Electrical impulse spreads from bundle

branches throughout left and right
ventricles which causes the ventricles to
contract, forcing them to expel their
volume of blood out into the general
circulation.

● S1 “lub” closing of MV and TV

OVERVIEW OF THE ANATOMY & ● S2 “dub” closing of PV and AV
PHYSIOLOGY OF THE CARDIOVASCULAR ● Abnormal heart sound:
SYSTEM ● Murmurs
● Extra sound S3, S4

NEUROLOGICAL ASSESSMENT

Cranial Nerve Assessment

 
Cranial Nerve Assessment
Nerve Name Function Test

I Olfactory Smell Have athlete smell a

familiar odor

II Optic Visual Acuity Have athlete identify

fingers
Visual Field
Check peripheral
vision
 III Oculomotor Pupillary Shine Light in the eye Support the forearm on the examiners forearm.
Reaction
Place your thumb on the bicep tendon
IV Trochlear Eye Movement Follow finger without
moving the head (located in the front of the bend of the elbow;
V Trigeminal Facial Touch the face
midline to the antecubital fossa). Tap on your
Sensation thumb to stimulate a response.
Have athlete hold
Motor Function mouth open
- Slight flexion of the elbow, and feel the bicep’s
VI Abducens Motor Function Lateral Eye
movements contraction through your thumb
VII Facial Motor Function Smile, wrinkle face,
puff cheeks
Sensory 
Tastes
VIII Acoustic Hearing Snap fingers by the
ear
Balance
Rhomberg's Test
IX Glossopharyngea Swallowing and Swallow and say "AH"
l Voice

X Vagus Gag Reflex Use tongue depressor

XI Spinal Accessory Neck Motion Shoulder shrugging

XII Hypoglossal Tongue Stick out tongue apply

Movement and resistance with a
Strength tongue depressor

Triceps Reflex (C7-C8)

Neurologic Examination
● Have the individual bend their elbow
while pointing their arm downward at
  
Reflex Response
90 degrees. Support the upper arm so

0 no response 
that the arm hangs loosely and “goes
1+ diminished, low normal 
2+ average, normal  dead”. Tap on the triceps tendon
3+ brisker than normal  located just above the elbow bend
4+ very brisk, hyperactive  (funny bone). 
● Observe the normal flexion and
Reflex hammer supination of the forearm.
● Fingers may extend slightly.

Biceps Reflex (C5 – C6)

Brachioradialis Reflex (C5-C6)
● Hold the person’s thumb so that the
forearm relaxes. Strike the forearm
about 2-3 cm above the radial styloid
process (located along the thumb side
of the wrist, about 2-3 cm above the
round bone at the bend of the wrist).
Normally, the forearm flexes and
supinate. 
forearm under the thigh closest to the
examiner, lifting the leg up. Reach under
the thigh and place the hand on the
thigh of the opposite leg, just above the
knee cap. Tap the knee closest to the
examiner, (the one that has been lifted
with the examiners forearm). 

Finger-to-Nose Test

Finger-to-Nose and to the Nurse’s Finger

● Ask the client to touch your nose and

then your index finger, held at about 45

cm (18 inches), at a rapid and

increasing rate.

Finger to nose test:

perform with eyes open and then eyes

Quadriceps Reflex (Knee jerk) L2 – closed.

L4

● Allow the lower legs to dangle freely.

Place one hand on the quadriceps.
Strike just below the knee cap. The
lower leg normally will extend and the
quadriceps will contract. 

● If the patient is supine: Stand on one

side of the bed. Place the examiners
 Fingers to Thumb (Same Hand)

● Ask the client to touch each finger of

one hand to the thumb of the same
hand as rapidly as possible.

  
Tandem walking: heel to toe on a straight
line
Fingers to Fingers

● Ask the client to spread arms broadly at

shoulder height and then bring fingers
together at the midline, first with eyes
open and then closed, first slowly then
rapidly.

Finger to finger test:

have the patient touch their index finger to your
index finger (repeat several times).
Romberg test: stand with feet together and
arms at their sides. Have the patient close
his/her eyes and maintain this position for 10
seconds. If the patient begins to sway, have
them open their eyes. If swaying continues, the
test is “positive” or suggestive of cerebellum
problems. 

Walking Gait
● Ask the client to walk across the room
and back and assess the client’s gait
● N- has upright posture and steady gait
with opposing arm swing, walks
unaided, maintaining balance
● A- poor posture, unsteady, rigid or no
arm movements
Standing on one foot with eyes closed
● Ask the client to close his eyes and
stand on one foot. Stand close to the
client during this test.
● N- maintains stance 5 sec.
● A- cannot
Toe or Heel Walking
● Ask the client to walk several steps on
the toes and then on heels
Alternating supination and pronation of
hands on knees
● Ask the client to pat both knees with
the palms of both hands and then with
the back of the hands alternately at an
increasing rate
Pain Sensation
Ask the client to close his/her eyes and say,
“sharp,” “dull,” or “don’t know” when the sharp
or dull end of the broken tongue depressor is
felt.
● Alternatively, use the sharp and dull end
of a sterile pin or needle to lightly prick
 designated anatomic areas at random.
The face is not tested in this manner.
● Allow at least two seconds between
each test.
Temperature Sensation
● Touch skin areas with test tubes filled
with hot or cold water.
● Have the client respond by saying “hot,”
“cold,” or “don’t know.”
 
Light Touch Sensation
● Compare the light touch sensation of
symmetric areas of the body.
● Ask the client to close eyes and to
respond by saying “yes” or “no”
whenever the client feels the cotton
wisp touching the skin.
● To test proprioception, grasp the
patient's index finger from the middle
joint and move it side to side and up
and down. Have the patient identify the
direction of movement. Repeat this
using the great toe.
 
One and Two-Point Discrimination
● Alternately stimulate the skin with two
pins simultaneously and then with one
pin. Ask whether the client feels one or
two pinpricks.
Stereognosis
● Place familiar objects such as a key,
paperclip, or coin in the client’s hand
and ask the client to identify them.
● If the client has a motor impairment of
the hand and is unable to manipulate
an object, write a number or letter on
the client’s palm, using a blunt
instrument, and ask the client to
identify it.
 Assessment of the Male and Female Genitalia

Assessment of the Anus and the Rectum

FEMALE GENITALIA AND INGUINAL

Extinction Phenomenon

● Simultaneously stimulate two

symmetric areas of the body such as the
 
thighs, cheeks, or hands.
● Explain in detail
● Not to douche 4-5 days
  ● Not to use vaginal creams, jellies,
medicines, or spermicidal foams 2-3
days before
● Can interfere with the cervical cells.
● Not to have sex 24 hours- tissue
inflammation
● Urinate
● Offer a mirror.

● FEMALE GENITALIA AND INGUINAL

Inspect the distribution, amount, and
characteristics of the pubic hair.
● Inspect the skin of the pubic area for
  parasites, inflammation, swelling, and
lesions. 
● To assess pubic skin adequately,
separate the labia majora and labia
minora.
● Pubic hair is distributed in an inverted
triangular pattern and there are no
signs of infestation.
● The labia majora are equal in size and
free of lesions, swelling, and
excoriation. A healed tear or episiotomy
scar may be visible on the perineum if
the client has given birth. 
● The perineum should be smooth.
● The labia minora appear symmetric,
dark pink, and moist. 
● The clitoris is a small mound of erectile
tissue, sensitive to touch. The normal
size of the clitoris varies. 
● The urethral meatus is small and
slit-like. 
● The vaginal opening is positioned below
the urethral meatus. Its size depends on
sexual activity or vaginal delivery.

● Inspect the clitoris, urethral orifice, and vaginal

orifice when separating the labia minora.
● Palpate the inguinal lymph nodes.
 ● Genital piercing is becoming more common,
and nurses may see male clients with one or

more piercings of the penis. 

● Inspect the urethral meatus for swelling,
inflammation, and discharge.
o Compress or ask the client to
compress the glans slightly to open
the urethral meatus to inspect it
MALE GENITALIA AND INGUINAL for discharge.
o If the client has reported discharge,
instruct the client to strip the penis
from the base to the urethra.
● Palpate the penis for tenderness,
thickening, and nodules. Use your thumb
and first two fingers.
● Inspect the scrotum for appearance, general
size, and symmetry.
● Empty bladder o To facilitate inspection of the
● Drape  scrotum during a physical
● Explain examination, ask the client to hold
● Wear disposable gloves the penis out of the way.
● Perform the examination professionally and o Inspect all skin surfaces by
preserve modesty. spreading the rugate surface skin
● Inspect the distribution, amount, and and lifting the scrotum as needed
characteristics of the pubic hair. to observe posterior surfaces.
● Inspect the penile shaft and glans penis for
lesions, nodules, swellings, and
inflammation.
● Pubic hair is coarser than scalp hair. 
● The normal pubic hair pattern in adults is
hair covering the entire groin area,
extending to the medial thighs and up the
abdomen toward the umbilicus.
● The base of the penis and the pubic hair are

free of excoriation, erythema, and

infestation.

● The skin of the penis is wrinkled and

● Palpate the scrotum to assess the status of
hairless and is normally free of rashes,
underlying testes, epididymis, and
lesions, or lumps.
spermatic cord. Palpate both testes
simultaneously for comparative purposes.
● Inspect both inguinal areas for bulges while
the client is standing, if possible.
o First have the client remain at rest.

o Next, have the client hold his

breath and strain or bear down as
though having a bowel movement.
● Palpate hernias.

RECTUM AND ANUS

Inspect the anus and surrounding tissue for color,
integrity, and skin lesions.
 ● Then ask the client to bear down as
though defecating.
● Describe the location of all
abnormal findings in terms of a
clock with the 12 o’clock position
toward the pubis symphysis.
● Palpate the rectum for anal sphincter
tonicity, nodules, masses, and tenderness.
● On withdrawing the finger from the rectum
and anus, observe it for feces. If ordered,
perform a test for occult blood on the stool.